Report Fraud and Abuse
Fraud and abuse are the number one threats to our healthcare system, costing Americans billions of dollars each year. Healthcare fraud is the intent to deceive a company into paying for services that either were not or should not have been provided. Those breaking the law could be physicians, patients, laboratories, hospitals, employees, vendors, or a billing service used by a provider.
Fraud and abuse can take many different forms, including:
- Billing for services or items that were not provided
- Billing for services or equipment that are more expensive than what was supplied
- Members allowing someone else to use their WHA ID card
- Identity theft
- Falsifying medical records
- Taking payment from another provider in exchange for a patient referral
WHA is committed to deterring, detecting and investigating healthcare fraud and abuse. But the fight against healthcare fraud and abuse is everyone's responsibility, including our employees, members, providers, hospitals and vendors. Through our compliance program we have established a toll-free hotline, which you can help by calling and reporting what you believe to be fraudulent or abusive actions.
For Commercial Members:
Contact the WHA Compliance and Ethics Hotline
You may leave your name and number, so we can contact you if we require additional information. But you may also remain anonymous. Either way, it is important that you provide as much information as possible so that we can investigate your concerns.
- The reason you believe that a fraudulent or abusive situation has occurred.
- Who is involved.
- Information regarding the item, service or issue in question.
- The date on which the item, service or issue in question was furnished or the incident occurred.
- The amount billed, if relevant.
- Any other information you have that is important to understanding the situation and will help with the investigation.
For Medicare Advantage Members:
Contact WHA Member Services
Mail: Western Health Advantage Mail Service
Attn: Member Services
PO Box 4457
Portland, OR 97208-4457
Please call our dedicated Member Services phone #: 888.942.4777.